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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Dahabo Adi Galgallo of the Kenya Field Epidemology and Laboratory Training Programme (FELTP) in Kenya, will develop a waterproof, coin-sized, solar-powered GPS-tracking device that will be fitted into cultural jewelry of expectant mothers in pastoralist and nomadic communities so health workers can easily locate and provide them with pre- and antenatal care where they are. Integrated maternal mobile health delivered to pastoralist women will decrease maternal mortality, infant mortality and improve vaccination coverage, which will improve infant survival in this population because women can easily be traced and care given. They will identify expectant women in Marsabit county and immunize them against tetanus, conduct laboratory profiling to detect any diseases for early intervention and provide continuous antenatal care from the duration of the pregnancy to birth and then immunization of newborns up to 12-month in tandem with continuous health education.

Jesse Gitaka of Mount Kenya University in Kenya will lead the development and deployment of a point-of-care diagnostic for bacterial infections that have been implicated in poor pregnancy outcomes such as premature deliveries, still births, maternal and newborn sepsis and deaths. Their project will enable quick detection of these bacteria allowing for prompt treatment. They will test whether treating for these bacterial infections, which are usually not diagnosed, improves pregnancy outcomes in field situations. This strategy has the potential to inform pregnancy monitoring and follow up practice and policy.

Christine Musyimi of Africa Mental Health Foundation in Kenya will engage Traditional Birth Attendants (TBAs) in rural Kenya to provide psycho-social interventions to mothers during the perinatal period and refer complicated cases of depression to health facilities. This approach aims to ensure accessible and acceptable basic mental health care in under-resourced areas while linking these mothers to primary health care to ensure safe deliveries and promote their mental well-being and that of the baby even after birth. TBAs were selected for this project as they are an important resource for reducing gaps related to the scarcity of mental health professionals and demanding workloads due to the high number of patients in primary health care settings as well as due to their accessibility and affordability, thereby promoting a sense of belonging to the TBAs.

Eric Ogola of Jaramogi Oginga Odinga University of Science & Technology proposes to reduce deaths in young children by developing an easier way to decide which antibiotic to use in blood-borne infections in children less than one month old. This will lead to judicious use of antibiotics and prevent the development of drug resistance. Clinicians in health facilities without laboratories will be able to make an educated guess on the best treatment that is likely to give an effective outcome. Authorities will also be able to monitor the rate of treatment failure and recommend new guidelines in time, thereby preventing more deaths over time.

Angela Koech Etyang of Aga Khan University in Kenya will make basic screening tests available to pregnant women at dispensaries and health centers that do not have laboratory facilities. These tests screen for conditions such as HIV, syphilis and anemia. They will employ simple existing technologies that enable these tests to be carried out during the clinic visit quickly, easily and by the nurse who is providing the care in pregnancy. They will evaluate whether introducing these tests as a package will integrate well with routine provision of care in these facilities and whether this will result in earlier screening and wider coverage of screening for pregnant women.

Niaina Rakotosamimanana of the Pasteur Institute of Madagascar in Madagascar will develop a low-cost tuberculosis diagnostic and molecular test for pregnant women using dried blood samples drawn from finger pricks. This dried-blood spot based test is minimally invasive, can be used in remote areas where people lack access to all-weather roads and lack of infrastructure that has direct impact on health outcomes. The dried-blood spot can be sent via mail to the health centers for testing without established cold chain methods and meets several of the criteria set by the World Health Organization regarding quality of TB diagnostic tools. Dried-blood samples have a wide range of diagnostic capacity and have been shown to have advantages over other biological samples in terms of cost, ease of collection, transport, and storage.

Diawo Diallo of Institut Pasteur de Dakar in Senegal will validate and implement a timely and up-to-date surveillance system of zika virus prevalence in the mosquito population in the Kédougou area using an innovative integrated device developed by Gopaul from Institut Pasteur in Paris. This 3-in-1 device includes a mosquito trap, an analysis station that will carry an antibody-based detection system with an easy to read color change result and a mapping software to create a real-time map of arbovirus infected mosquitoes. The outcome will be the production of tools that can be used to implement focused and ecofriendly vector control interventions to improve maternal and neonatal health.

Muriel Vray of Institut Pasteur of Dakar in Senegal will evaluate a loop-mediated isothermal amplification assay (LAMP), a simple, robust and inexpensive nucleic acid amplification assay, to quantify/semi-quantify hepatitis B virus (HBV) DNA levels in Senegal. In the first step, they will validate the assay in a reference laboratory in Dakar, compared with the reference standard PCR assay. In the second step, they will validate the assay in a decentralized context at a rural health center in Senegal. They will also evaluate the feasibility and acceptability of the use of LAMP.

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